Ecraid’s Response to the WHO GLASS AMR Crisis

The European Clinical Research Alliance on Infectious Diseases (Ecraid) stands as Europe's operational infrastructure designed precisely to meet this requirement. Founded to establish a self-sustainable, pan-European network, Ecraid is the long-term strategic vehicle for translating global surveillance data into effective clinical interventions against AMR and other infectious disease threats.

Bridging the Gap: From Crisis Identification to Clinical Solution 

The WHO report highlights two critical areas of failure in the global AMR response: 

• fragmentation in surveillance
• a profound crisis in the antimicrobial research and development (R&D) pipeline. 

The report explicitly calls for action to strengthen surveillance systems and accelerate innovation in new drugs, diagnostics, and treatment regimens.

Traditional clinical research models, often characterised by slow site activation and resource inefficiency, are ill-equipped to respond to the rapidly evolving threat of AMR. 

Ecraid's response is the implementation of a ‘warm-base’ clinical research network. This concept represents a permanent, prepared, and continuously engaged infrastructure, offering a single point of access to high-quality clinical sites across Europe.

By establishing this ‘warm-base’ (built upon the foundations of former EU-funded programmes such as COMBACTE) Ecraid effectively bypasses the systemic delays inherent in traditional study initiation. This fundamental shift in operational methodology accelerates the testing of new therapeutic and diagnostic interventions, directly addressing the pipeline and time-to-market crisis identified by the WHO.

Crucially, Ecraid's network is designed not just for rapid study activation but also for methodological innovation. The Alliance is a European partner in the Randomised, Embedded, Multi-factorial, Adaptive Platform trial for Community-Acquired Pneumonia (REMAP-CAP). Adaptive Platform Trial (APT) methodology is fundamental to preparedness, allowing multiple research questions, interventions, and patient populations to be studied simultaneously and adjusted based on accumulating data. This flexibility ensures highly efficient evidence generation, a necessity when confronting fast-moving crises like pandemics or rapidly changing AMR profiles.

Targeting high-AMR risk infections 

• POS-cUTI (complicated Urinary Tract Infections): Directly tackles infections where resistance, particularly in Gram-negative bacteria like E. coli, is rapidly increasing. This platform facilitates the rapid evaluation of new agents and stewardship protocols in a high-burden setting.
• POS-VAP (Ventilator-Associated Pneumonia): Focused on Intensive Care Units, a setting with the highest burden of multi-drug resistant hospital-acquired infections, ensuring the necessary infrastructure to test critical care interventions and diagnostics against highly resistant pathogens.

Enhancing stewardship and preparedness 

• POS-ARI-PC (Acute Respiratory Infections in Primary Care): Addresses the most common reason for antibiotic prescribing - respiratory infections in the community. By describing the aetiology, management, and outcome of ARI, this POS is crucial for benchmarking practice, informing national guidelines, and supporting antimicrobial stewardship efforts.
• POS-ARI-ER (Acute Respiratory Infections in Emergency Rooms): Focused on acute hospital settings, this study characterises ARI to better understand routine diagnostic and therapeutic practices. Its core function is to facilitate the rapid implementation of clinical trials for improved diagnostics and targeted treatments, thereby reducing the reliance on empirical, broad-spectrum antibiotic use.
• POS-Disease X (Unexplained Febrile Illness): While focused on Emerging Infectious Diseases (EID) and pandemic preparedness (e.g., coronaviruses, arboviruses), this study is vital to the AMR response. It prepares the network to rapidly implement protocols during outbreaks, preventing the widespread, unnecessary use of broad-spectrum antimicrobials that often occurs in an unknown infectious event, thereby safeguarding the remaining arsenal of effective drugs.

Furthermore, Ecraid bolsters the surveillance pillar of the WHO's global action plan through its epidemiology network – EPI-Net. EPI-Net actively strengthens the monitoring of healthcare-associated infections and AMR across Europe by harmonising and integrating multiple surveillance data sources. This effort provides the crucial epidemiological context necessary to inform targeted site selection and rigorous trial design, enabling Ecraid to estimate the burden of resistant infections, such as cUTI, with greater precision.

Sustaining Europe's Response

The WHO GLASS report is a definitive reference point for collective accountability and sustained strategic investment. It mandates that global efforts transition from fragmented, reactive projects to permanent, coordinated, and scalable infrastructures.

Ecraid embodies this transition. By operationalising a unified ‘warm-base’ clinical research network supported by innovative APTs and five strategically focused POS studies, Ecraid ensures Europe has the dual capacity to efficiently generate the rigorous evidence needed for new diagnostics and therapeutics, both against established resistant pathogens and emerging viral threats. This holistic approach, spanning from the primary care community to the intensive care unit, is key to safeguarding the efficacy of antimicrobials for the future. The continued function and expansion of this centralised infrastructure represent a critical mechanism for the global community to strengthen the clinical pipeline, ensuring that the WHO’s findings translate into impactful and lasting public health solutions.